General Permits (3081)

Applicant Name _
Address rs:
City
Project Location
CERTJ-F4,CATION;OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina, ✓tip""
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
�e % Gt• �f�S Phone Number ?;K� 77t09-
Type and Dimensions of Project
Water Body, etc.)
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant-4o-a�&-KOAC•7K .0203. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
SKETCH
State
E
This certification of exemption from requiring a CAMA permit is
valid for 90,days from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
c-,1
(SCALE:
617
P,_ r C""S r ev /A/
F
Any person who proceeds with a development without the con-
sent of a CAMA official under the mistaken assumption that the
development is exempted, will be in violation of the CAMA if there
is a subsequent determination that a permit was required for the
development.
The applicant certifies by signing this exemption that (1) the ap-
plicant has read and will abide by the conditions of this exemp-
tion, and (2) a written statement has been obtained from adjacent
landowners certifying that they have no objections to the
proposed work.
App'lican't's siignaturb`,
1p' /J'- C//I -, �I
LAMA Official's signal re
- ! b -
Issuing date
`1 ? i - ?
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203